Request for Accelerated Payment; Certifications Required from Individuals Electing Accelerated Payments; and Agreement with Educational Institution

Attachment C

Hi Tech Verification of Completion Letter

Dear

The law requires that we collect some information about the Accelerated Payment of $(####.##) we sent you on (month-dd-yyyy). Your responses are only for statistical use. Although your responses are only for statistical use, the law requires that you provide this information as a condition for keeping this Accelerated Payment. If you don’t answer before (month-dd-yyyy), you must repay the Accelerated Payment.

Did you receive a grade for this course(s) that counts toward graduation?

? YES ? NO

(If you check “NO,” please use the back of this letter to explain.)

Check the box below showing the primary use of your Accelerated Payment. (VA will only use this information for statistical purposes. There is no right or wrong answer.) If needed, use the back of this letter to clarify.

Education related items (tuition, fees, books, supplies, etc.)

Personal items (room, board, living expenses, etc.)

Savings or checking account

Travel or entertainment

Loan repayment

Other (specify)

Please sign and return this letter to our office.

I certify that the information above is true and correct to the best of my knowledge and belief.

SIGNATURE OF STUDENT Date Signed

HI TECH VERIFICATION OF COMPLETION LETTER

IMPORTANT NOTICE ABOUT INFORMATION COLLECTION.

Privacy Act Notice: VA will not disclose information collected by this information collection to any source other than what has been authorized by the Privacy Act of 1974 or Title 38 Code of Federal Regulations 1.576 for routine uses as identified in VA’s system of records, 58 VA 21/22, Compensation, Pension, Education and Rehabilitation Records – VA as published in the Federal Register at http://www.va.gov/privacy/systemofrecords/58va21.asp. An example of a routine use (e.g., VA sends educational forms or letters with a veteran's identifying information to the veteran's school or training establishment to (1) assist the veteran in the completion of claims forms or (2) for the VA to obtain further information as may be necessary from the school for the VA to properly process the veteran's education claim or to monitor his or her progress during training). Your obligation to respond is required to obtain or retain education benefits. The requested information is considered relevant and necessary to determine the maximum benefits under the law. Payment of education benefits cannot be made unless the information is furnished as required by existing law (38 U.S.C. 3471). The responses you submit are considered confidential (38 U. S. C. 5701). Any information provided by applicants, recipients, and others may be subject to verification through computer matching programs with other agencies.

Respondent Burden: We need this information to confirm your entitlement to the Accelerated Payment we issued you (38 U. S. C. 3014A). Title 38, United States Code , allows us to ask for this information. The Office of Management and Budget has approved this information collection under OMB control number 2900-0636. We estimate that you will need an average of 5 minutes to review the instructions, find the information and complete the form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at www.whitehouse.gov/omb/library/OMBINV.VA.EPA.html#VA. If desired, you can call 1‑888-GI-BILL-1 (1‑888‑442‑4551) to get information on where to send comments or suggestions about this information collection.

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